Association between unmet needs and quality of life of cancer patients: A population-based study (original) (raw)

Background. Two conceptually different morbidity outcomes unmet needs and health-related quality of life are used to identify cancer patients in need of clinical attention and to evaluate rehabilitation programmes. The knowledge on the interrelation between unmet needs and health-related quality of life is scarce. This paper studies the hypothesis that patientperceived unmet needs of rehabilitation during the cancer trajectory are associated with decreased quality of life. Material and methods. Based on registers, a Danish population-based cohort of adult, incident, mixed-site cancer patients diagnosed between 1 October 2007 and 30 September 2008 was established. At 14 months following diagnosis participants completed a questionnaire including health-related quality of life (EORTC QLQ C-30), psychological distress (POMS-SF), and unmet needs with regard to physical, emotional, family-oriented, sexual, work-related, and fi nancial problems. Unmet needs were assessed through six ad hoc questions. Results. Questionnaires were received from 3439 of 4947 patients, resulting in a response rate of 70%. The three most frequent cancer types were breast (28.4%), prostate (14.6%) and colorectal cancer (15.2%). Overall, 60.1% expressed an unmet need of rehabilitation in at least one area, physical and emotional problems being the most frequent (40.0% and 37.5%). For all scales of the EORTC QLQ C-30 and POMS, signifi cant adjusted mean differences were observed between patients with unmet needs in at least one area and patients with no unmet needs (p-values Ͻ 0.001). These differences were well above levels usually considered clinically relevant. Further, impairment increased with increasing number of areas in which unmet needs were reported. Discussion. We confi rmed the hypothesis that patient-perceived unmet needs of rehabilitation during the cancer trajectory are associated with decreased quality of life. This study supports the use of unmet needs questions to identify patients in need of clinical attention. Interventions reducing cancer patients ' perceived needs of rehabilitation may enhance quality of life. Cancer patients face various symptoms related to their disease and treatment, such as fatigue, depressive symptoms, lymphedoema and other bodily changes [1,2]. Anxiety and fear of recurrence may be overwhelming. Physical, psychological and social problems may thus affect daily functioning in a way that reduces health-related quality of life [3]. Cancer rehabilitation addresses these problems and aims to enhance daily functioning and quality of life through different professional interventions. Psychological counselling, physical training, information, assistive technologies, pain, fatigue and depression reductive strategies are examples of the wide variety of interventions that may be needed. Cancer patients expect the healthcare system to be aware of their cancer-related problems during treatment and follow-up [4-6]. However, studies of different cancer groups have shown that often these problems are not appropriately addressed by professionals, which may give rise to the perception of unmet needs of rehabilitation [2,7]. Patients frequently report that they have not received the desired support during treatment and follow-up [1,2,8]. Two conceptually different morbidity outcomes, unmet needs and health-related quality of life, are used to identify cancer patients in need of clinical attention and to evaluate interventions for cancer patients [9,10]. Unmet needs refer to patients ' experiences with individual help from professionals in the past and covers a range of issues, whether